Individual
JASON MAYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
62 W 7TH AVE STE 110, SPOKANE, WA 99204-2321
(509) 462-6485
(509) 462-5059
Mailing address
62 W 7TH AVE STE 110, SPOKANE, WA 99204-2321
(509) 462-6485
(509) 462-5059
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA19289
CA
363AS0400X
Surgical Physician Assistant
Primary
PA60698165
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0PA192890
MEDICARE INDIVIDUAL PTAN
—
01
—
PA19289
LICENSE
CA
Enumeration date
11/15/2006
Last updated
06/17/2021
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